| NPI | 1558566612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001814-1) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2016-05-03 |